New Eng J Med Vol 354
1567 Homocysteine is a tricky blighter: unstable in blood, linked with cardiovascular disease, lowered by several B vitamins — folic acid, pyridoxine and cobalamin. But the big Canadian HOPE 2 trial showed no protective effect from these vitamins in people with vascular disease or diabetes, although they did lower homocysteine.
1698 ‘I'm afraid there's nothing we can do to stop the poor mite vomiting’, you say, carefully moving to a safe place and switching on the fan. Oh, but soon there will be. Ondansetron as a melting tablet reduced vomiting in children with gastroenteritis in a big placebo controlled US trial.
1787 The amount of levothyroxine that people absorb is reduced if they carry H pylori or take regular omeprazole.
1796 More bad news about the antioxidant vitamins C and E: they don't prevent pre-eclampsia in nulliparous women.
1879 A self-expanding stent is what your patients need in their superficial femoral artery if it blocks, according to a trial comparing these with balloon angioplasty and conventional stenting.
Lancet Vol 367
1247 A new vaccine against human papilloma viruses 16 and 18 may prevent cervical cancer, even in those not vaccinated. Hurrah for herd immunity.
1343 Your defective, one-sided view of amblyopia can be cured by a good Lancet review, just as the condition itself can by an hour or two of patch wearing a day, or even by a drop of atropine twice a week.
1399 Marburg virus may no longer spell doom: a new filoviral virus not only prevents it in rhesus monkeys, but works even given after exposure.
1412 If you want men to get fewer women pregnant, give them more testosterone. Pills, patches and implants switch off male gonadotrophic hormone and cause infertility which is fully reversible within 6 months.
1503 Comparison with the gold standard of intra-arterial carotid angiography shows that ultrasonography is dependable at finding the occlusions that matter most — those between 70 and 99%.
JAMA Vol 295
1647 The Women's Health Study shows that unopposed equine oestrogen given to women without a uterus doesn't increase breast cancer but does increase deep vein thrombosis (DVT), slightly.
1668 More good news about herd immunity: giving babies conjugate pneumococcal vaccine spreads protection even to unvaccinated babies (and vulnerable adults).
1775 A randomised trial of mercury amalgam fillings versus non-mercury in American children finds no difference in measures of coordination or intelligence 5 years later.
1824 A systematic review into why women get more migraines — the culprit may simply be oestrogen.
1901 Shocking news about implantable defibrillators — they are prone to malfunction and this can be fatal.
2037 If you're over 50 in England, you'll be paying half as much for your health care as the average American, and be quite a lot healthier in almost every way.
2057 A systematic review of non-hormonal therapies for menopausal flushes confirms what you know: they don't work.
Arch Intern Med Vol 166
729 Once someone's had a DVT, should they have a ‘thrombophilia screen’ for Factor V Leiden and prothrombin G20210A? This systematic review suggests no: it doesn't change management.
743 Fibrates may make a come-back following an analysis of 18 year results from a trial of gemzofibril, showing a marked reduction in events in obese patients with high triglycerides.
869 If you feed chalk tablets to osteoporotic elderly women, be prepared to find that many don't take them, but that those who do get fewer fractures.
909 Patients with high blood pressure should have an ECG — not for left ventricular hypertrophy but for a more predictive measure — the adjusted QT interval.
Ann Intern Med Vol 144
554 More evidence (from Japan) that caffeine prevents diabetes, taken as coffee or green tea.
625 Laparoscopic adjustable gastric banding proves highly effective at reversing obesity in moderately fat Australians.
Guest Journals: Chest (Vol 129) and Thorax (Vol 61)
Much of general practice is chesty and thoracic, so these are useful journals. Chest reminds us (page 1282) that a common cause of death in cardiac patients is pulmonary embolism — how often do we miss it? Thorax discusses the evidence for preventing exacerbations of COPD (page 440) and carries a whooshy editorial: Got a match? Home oxygen therapy in current smokers (page 374).
Plant of the Month: Magnolia x wieseneri
The spectacular flowers last a mere night or two, but fill your garden with an unearthly fragrance — plant it if you dare.
- © British Journal of General Practice, 2006.
